ACA Blog

Barbara Jordan
Jan 10, 2011

Clinical Supervision

During my first several years as a co-occurring disorder therapist, I paid little attention to clinical supervision. Oh, don't get me wrong. I sought supervision on a regular basis. I showed up to clinical staffings with a tower of charts in hand. I asked questions, sought advice, and received feedback gracefully. However, at some level, I took it for granted. I didn't value clinical supervision nearly as much as I do now. Of course, I value it now because I am a counselor educator and clinical supervisor myself.



More recently I've been studying and teaching others what makes an effective supervisor. In my trainings, several questions emerge. For example, why do we need to concern ourselves with clinical supervision anyway? Research shows that effective clinical supervision leads to improved:
•clinical skills for both supervisor and supervisee
•therapeutic relationships
•therapy outcomes

Clinical supervision improves the services we provide our clients. It increases counselor job satisfaction and decreases burnout and staff turnover. Clinical supervision also improves staff communication and teaches counselors critical skills. Clinical supervisors can help supervisees develop:
•competency in helping skills/techniques
•emotional awareness (self-awareness, self-control, issues of transference/counter-transference)
•autonomy
•theoretical integration and identity/consistency
•respect for individual differences (tolerance/acceptance of diversity)
•therapeutic direction
•appropriate professional development goals
•professional ethics

According to Treatment Improvement Protocol (TIP) Series 52, a DHHS Publication of the Substance Abuse and Mental Health Services Administration (SAMHSA), "Clinical supervision has become the cornerstone of quality improvement in the substance abuse treatment field. In addition to providing a bridge between the classroom and the clinic, clinical supervision improves client care, develops the professionalism of clinical personnel, and imparts to and maintains ethical standards in the field."

As I began my career as a clinical supervisor, I struggled with issues such as 1) how do I supervise interns and entry-level counselors?; 2) how do I supervise those with 5-10 years experience?; and, 3) how do I go from peer to supervisor with veteran counselors who practiced right alongside me for years?

On page 10 of TIP 52 is a chart derived from the work of Stoltenberg, Delworth, & McNeil (1998). The table illustrates how we can provide clinical supervision appropriate to each of these three levels of counselor development. According to this model, counselors at level 1 tend to focus on themselves, are anxious and uncertain, and can become preoccupied with doing things "the right way". Therefore, clinical supervisors need to provide structure and minimize anxiety. Because they typically over-generalize, rely too much on certain skills, and need to develop ethics, clinical supervisors should be supportive, start with their strengths, and suggest approaches. Supervision techniques that seem to work well with this entry-level counselor include observation, skills training, role-playing, readings, group supervision, and close monitoring.

Counselors at level 2 tend to focus less on self and more on clients, become frustrated or confused with the complexity of cases, and over-identify with clients. Therefore, clinical supervision with these counselors needs to be less structured and more supportive and suggestive while encouraging more autonomy. Because these mid level counselors start to challenge authority and begin to understand ethics, clinical supervisors may want to confront their discrepancies, introduce alternative views, and process transference/counter-transference issues. Techniques Stoltenberg, et. al. (1998) suggest for this level of counselor include observation, role-playing, interpreting group dynamics, group supervision, and readings.

Finally, at the third, most experienced level, counselors tend to focus more exclusively on clients. According to Stoltenberg, et. al. (1998) they also typically have an advanced level of empathic listening. They tend to take an objective, neutral stance, and have an integrative approach. These veteran counselors also seem to have the most responsibility and ethical awareness. Considering these traits, clinical supervisors ought to focus on personal-professional integration, develop a supervisee-directed relationship, and be even more supportive. Stoltenberg et. al., (1998) suggest using peer supervision, group supervision, and readings with this group. I'm thankful that free publications like the TIP 52 are made available to those of us leaders in the helping profession. This resource has proved to be an excellent tool for me as I continue to teach counselors-in-training.



Barbara Jordan is a counselor, counselor educator, author, trainer, and leadership coach. For more information go to www.AdvantEdgeSuccessCoaching.com.

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